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February 28, 2026Circulation Journal1 citationsOpen Access

Aspirin Added to Warfarin After Mechanical Valve Replacement ― Cautionary Lessons From the ASPIRIN Trial ―

NTNobuaki Tanaka

Key Result

Adding aspirin to warfarin did not significantly reduce the primary atherothrombotic composite endpoint compared to warfarin alone in Japanese patients with mechanical valve replacement (22.0% vs 13.7%, P=0.13).

Structured PICO

Does aspirin added to warfarin improve outcomes in Japanese patients with mechanical valve replacement?

P
Population
158 Japanese patients with mechanical valve replacement from 11 university hospitals in Kyushu and Okinawa
I
Intervention
Aspirin added to warfarin (n=84)
C
Comparator
Warfarin alone (n=74)
O
Outcome
Primary atherothrombotic compositecomposite

The observations support a cautious, indication-driven approach in which aspirin is used selectively as an adjunct to warfarin rather than as a default strategy in Japanese patients with mechanical valves.

Main Result

Absolute Event Rate: 22% vs 13.7%

p-value: p=0.13

Limitations

  • Small sample size
  • Treatment selection bias in routine care due to observational design
  • Small numbers
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Cite This Study

Nobuaki Tanaka (2026) conducted an editorial in Mechanical valve replacement (n=158). Warfarin plus aspirin vs. Warfarin alone was evaluated on Atherothrombotic composite including cardiovascular death (p=0.13). Adding aspirin to warfarin did not significantly reduce the primary atherothrombotic composite endpoint compared to warfarin alone in Japanese patients with mechanical valve replacement (22.0% vs 13.7%, P=0.13).

synapsesocial.com/papers/6a025a659cddff7633412be0https://doi.org/10.1253/circj.cj-25-1147
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The East Asian Paradox: An Updated Position Statement on the Challenges to the Current Antithrombotic Strategy in Patients with Cardiovascular Disease2020 · 352 citations
  2. 2Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40 to 75 Years of Age2025 · 54 citations
  3. 3Management Strategies for Patients With Atrial Fibrillation-Related Ischemic Stroke Despite Oral Anticoagulation2025 · 5 citations
  4. 4Prevalence of Guideline-Discordant Aspirin Use and Associated Adverse Events in Patients on Warfarin for Mechanical Valve Replacement2024 · 4 citations
  5. 5Efficacy and Safety of Warfarin for the Treatment of Venous Thromboembolism ― A Multicenter Prospective Observational Cohort Study in Japan (AKAFUJI Study) ―2023 · 7 citations